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Adrenaline-Like Rushes - Pots Or Panic Attacks??


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Hi everyone. I'm hoping you can help with this debilitating symptom. I started having major POTS symtoms while pregnant in 2011 (confirmed by a ttt last October). I have typical POTS symptoms while standing / walking (heart racing, nausea, lightheadedness), but also many of the same symptoms while siting. The worst are these panic attack-like symptoms - adrenaline rush, tachycardia, faintness, anxious feeling, shaking. This happens predominantly after lunch, around 3-4pm, after dinner and around 9pm. Almost like clockwork!! I take Propranolol and Klonopin 3x per day, but these "attacks" still occur. They seem to come out of nowhere and aside from the anxiety they produce, I don't feel anxious and would think the Propranolol and Klonopin would prevent panic attacks, if they were anxiety-driven. I'm so confused! For those of you that experience this, is this part of POTS? Do you get symptoms while sittig? Does anyone have this happen daily? Has anything helped you? I've cut down on carbs and sugar, which definitely seem to be triggers for me, and eat frequent small meals. Sorry for all of the questions, but these attacks are really preventing me from doing so much :(

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Two drugs that you may want to talk to dr about is Methyldopa and clonidine. they are same class of drugs and both have similar effects of reducing sympathetic tone and would have similar side effects. methyldopa provides more steady effects and that the advantage of methyldopa is that it reduces activation of both alpha and beta receptors. I don't have POTS but severe adrenaline surges and hyperadrenergic form of dysautonomia. Those surges for me would come on regardless of position and it can be very scary. Some times it would be everyday. it had a mind of its own. Had to go to ER couple times because the surge got unbearable and wouldn't let up. Afraid I was going to have a heart attack. I have never tried clonidine but many others on this site have experience with it. I been on methyldopa for 4 years and it got rid of adrenaline surges. It will lower blood pressure so I don't know if low blood pressure is an issue for you. I am sure others out there in the forum can offer other suggestions whether it is meds or not that have worked for them to tone down their adrenaline surges. Hang in there!

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linda,

I was dx in 2009 with POTS and I have to say my worst symptom at the time was anxiety-panic-like attacks (in fact that is how this all started with me and then I was dx via TTT in 2009). I almost became an agoraphobe! One thing that really helped me was Xanax (I'm on .5mg 3x/day). Previously I had been put on Celexa (SSRI) that I did not tolerate at all. Then, I was put on Buspar and Prozac (SSRI). I never took the SSRI--gotta love how doctors listen to you and your previous experiences!! Do they even bother listening or reading what we write on all the paperwork they make us fill out? It wasn't until I went to a new GP (have had him now for a few years and he treats a few other POTS patients) and he put me on Xanax. Said it was fast acting and a tried and true medication. Quite frankly, I'd rather take an old medication that's been on the market than to try some newly placed med where they don't really know the long-term effects). I really feel that it has made all the difference in the world. I can even double up if necessary if I know that I will be especially stressed that day (ie: driving) and I double up sometimes if I just feel more anxious than usual. I personally have found this med to be most beneficial. Although, keep in mind that all of us are different and respond differently to drugs. I really think that Xanax has made all the difference in the world for me. I am always careful in how much I take as it is a controlled substance and I suppose some people can become addicted. Always talk to your dr. about anything you might take.

Hope you get some answers and begin to feel better :)

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bebe127 - Wow - that is exactly how I feel - borderline agoraphobic! Thanks for sharing your experience - I'll ask my dr. if I can increase my Klonopin dose (very similar to Xanax, but longer acting (I think..). My dr.'s latest suggestion was Adderall, but it's been nearly impossible to get my insurance to cover it. Also very curious about Clonidine...

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A lot of our medication regimens can be trial and error until we find the right one or combo. I am curious as I have seen it mentioned a couple times on the forum when it is suggested to take Adderall when adrenaline surges exist. I understand it is a central nervous system stimulants that affect chemicals in the brain and nerves that contribute to hyperactivity, like ADHD. Have not been able to find a mechanism of action by this drug that would decrease adrenaline or adrenaline like symptoms. Could you explain to me why your Dr suggested this drug for your adrenaline rushes?

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Sorry to cut in on one possible answer here. I've recently started on Addreall and it is one of the best meds I've tried so far. It does not help or hurt during my crashes- every day or two I spend a day or two in bed crashing where My sympathetic system shuts down my parasympathetic system and it is like being in a full trauma- digestion stops, every nerve on overload, difficulty breathing etc.

BUT

On my ok days, for the first time in almost 2 years I have a clear head and a little more energy.

So keeping in mind that most of our treatments are counterintuitive Adderall is no different. Three big reasons why it helps:

1. It is a very powerful vaso dilator

2. It stimulates circulation

3. It tricks the sympathetic nervous system with the presence of synthetic adreneline so it doesn't think it has to produce as much natural adrenaline.

As a side note, before I had a diagnosis (in the first month following my onset) I would get almost daily adrenal surges that looked, acted and felt like panic attacks- almost exactly as described above. They would always be preferred by this overwhelming wave of pre syncope that was the worst feeling in the world- like dying, which I still get from time to time minus the palpitations, exposing pain and tremors/body shaking. I don't know why they stopped but I suspect they were huge adrenal dumps that were uncontrollable.

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Propanolol and Klonopin aren't meant to stop panic attacks. The propanolol definately not, the klonopin has a side effect that can sedate so that could help in theory but it's not meant for that. I have had symptoms sitting and when the flare is really bad, also lying and it can sorta feel like anxiety. Sometimes I think the tachycardia/chest pain/palpitations themselves can make me a bit anxious; I know I'm ok but it's disconcerting.

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Methyldopa will lower blood pressure and it lowered mine. For example, I was running 130-140's/80-90's at rest with tons of cardiac symptoms. Surge BP would go much higher and symptoms more intense. For me, 250mg BID I was running at rest on avg. 110/60-70's with no surges but it really didn't suppress my cardiac or dysautonomia symptoms.

Yes, it can effect heart rate since it reduces activation of beta receptors. Not to the same degree as a beta blockers since it truly blocks receptors from effecting heart rate. Methyldopa will not effect HR increase with activity.

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speaking of adrenaline surge. something happened to me last night. i had gotten this burning sensation inside my body, my pupils were dilated and things looked foggy. i was scared. i didn't know if i was having a mast cell attack or my nervous system is just really whacky. i wonder if Methyldopa and clonidine could help me. these episodes have to stop. scares the heck out me.

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Methyldopa will lower blood pressure and it lowered mine. For example, I was running 130-140's/80-90's at rest with tons of cardiac symptoms. Surge BP would go much higher and symptoms more intense. For me, 250mg BID I was running at rest on avg. 110/60-70's with no surges but it really didn't suppress my cardiac or dysautonomia symptoms.

Yes, it can effect heart rate since it reduces activation of beta receptors. Not to the same degree as a beta blockers since it truly blocks receptors from effecting heart rate. Methyldopa will not effect HR increase with activity.

Buster, Am glad Methyldopa lowered your BP and not interfering with heart function.

I have low BP, and had a concern about taking Methyldopa. It seemed counter-intuitive to me to take a medication for high BP when my BP is low.

Oddly, it hasn't lowered mine. Am taking 250 mg three times a day.

Could NOT tolerate beta blockers as they lowered by BP to an extreme (80 over 40), and they're not for hyper pots anyway. (They were prescribed before it was determined that I had hyper pots.)

So it's a bit of an enigma to me that Methyldopa does not lower my BP.

Definitely has a powerful impact on the sympathetic excess though. Not only has it dramatically helped with sleep, but also with surges, and cold sweats. Have only been on it for 2 and a half weeks, but it's been amazing thus far.

Now if it would only help with cognitive function!

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